Suspension of Two IMEs Raises Questions About Review System

The New York Workers’ Compensation Board has removed two medical evaluation firms from its list of authorized providers.

The board did not explain why the firms were banned from the system, but the CEO of one company, Independent Claims Evaluations Inc., said it was probably because his company went out of business earlier this year.

Another said he was unaware of the action by the board, but that he didn’t care because he was so fed up with the agency’s bureaucracy.

"If they want to suspend me, they can knock themselves out," said Tom Major, CEO of Aimes Enterprises, which provides medical reviews on injured workers in 10 other states. "I wouldn’t do another IME in New York if they paid me $1,000 a minute."

Major, other IMEs, attorneys and a labor official said Wednesday that the de-listing of the two companies may signal something of a change in enforcement efforts by the board, which has been criticized for allowing problems to fester, including low fees paid to some review companies, which encourages superficial and inaccurate reviews.

Regulations allow the board to de-authorize an IME for lack of compliance with rules and laws, professional misconduct, incompetence and other reasons. Claimants' attorneys said it's rare for evaluators to be removed and usually involves something egregious.

Although the board does not set fee schedules for IMEs — fees are negotiated with insurance carriers — it has provided little oversight for the system, said labor lobbyist Art Wilcox. Some IME companies will accept as little as $50 per review from insurance carriers, which has led to some firms and their physicians taking on dozens of reviews per day and rushing through each one, he said.

"Maybe there needs to be some minimum level of compensation to ensure a degree of quality," Wilcox said.

Some claimants’ lawyers now ask their clients to videotape and time the reviews, to show in hearings that the evaluations were not done thoroughly, said attorney Joe Sensale, treasurer of the New York Workers’ Compensation Alliance.

"Some IMEs do a thorough job, but we’ve heard from many, many claimants that their exams are less than thorough, take just a few minutes, they’re not done in a doctor’s office, just a rented room, and it’s not clean," Sensale said.

In many cases, a review doctor will file a report indicating that an injured worker has a disability. But after an appeal is filed by an insurer, the same doctor will file a report with identical facts but will note that the claimant has no disability at all, Sensale said.

Because IMEs are paid by insurance carriers, they have little incentive to provide objective reviews of an injured worker’s medical needs, he said.

The expulsion of the two IMEs comes more than a year after the New York Legislature required the Workers’ Compensation Board to study the entire IME system, so that an advisory committee can review the findings and make recommendations for improvements in 2019.

The study is still underway, said Melissa Stewart, director of public information for the board. She did not indicate if this week’s actions were related to the study or an effort to improve the IME system.

"That’s the best thing that’s happened, is that the Legislature said they have to take a look at the system now, and they appear to be doing that," Wilcox said.

Medical evaluation firms reached by WorkCompCentral said their physicians are fair and impartial in their reviews. But several said the board could improve the process significantly with better oversight and less red tape.

"New York is probably the most bureaucratic of all the jurisdictions we deal with," said Dylan Bury, an analyst with Labor Management Specialists Inc., with offices in Clifton Park, New York. "It’s often an arduous ordeal."

"New York is tough to deal with. A lot of rules and regulations," said Audrey Reynolds, operations manager for Independent Medical Evaluation Co., based in Carthage, New York.

The evaluation firms said their beef is not with the pay levels for exams, but with the lack of response from the board, and the layers of bureaucracy they must spend time on.

Major said Aimes Enterprises began workers’ compensation medical evaluations in New York 14 years ago. "It’s been the same problems all along, just more of it is coming to light now," he said.

He said that the Workers’ Compensation Board staff would rarely return phone calls from his firm, or his staffers would be placed on hold for as much as an hour at a time.

Many times, he said, he or a staff member would file a report and not hear anything from the board for days. When he would call to see if the board received the report, an agency worker would tell him that no information could be provided because the IME was not a party to the claim.

"But if your report is more than 10 days late, you don’t get paid," Major said.